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1. A client with a missed abortion at 29 weeks gestation is admitted to the hospital. The client will most likely be treated with:
- Magnesium sulfate
- Calcium gluconate
- Dinoprostone (Prostin E.)
- Bromocrystine (Pardel)
2. Upon assessment the nurse found the following: fundus at 2 fingerbreadths above the umbilicus, last menstrual period (LMP) 5 months ago, fetal heart beat (FHB) not appreciated. Which of the following is the most possible diagnosis of this condition?
- Hydatidiform mole
- Missed abortion
- Pelvic inflammatory disease
- Ectopic pregnancy
3. A 39-year-old at 37 weeks gestation is admitted to the hospital with complaints of vaginal bleeding following the use of cocaine 1 hour earlier. Which complication is most likely causing the client’s complaint of vaginal bleeding?
- Placenta previa
- Abruptio placentae
- Ectopic pregnancy
- Spontaneous abortion
4. A client in the first trimester of pregnancy arrives at a health care clinic and reports that she has been experiencing vaginal bleeding. A threatened abortion is suspected, and the nurse instructs the client regarding management of care. Which statement, if made by the client, indicates a need for further education?
- “I will maintain strict bedrest throughout the remainder of pregnancy.”
- “I will avoid sexual intercourse until the bleeding has stopped, and for 2 weeks following the last evidence of bleeding.”
- “I will count the number of perineal pads used on a daily basis and note the amount and color of blood on the pad.”
- “I will watch for the evidence of the passage of tissue.”
5. A pregnant client is making her first Antepartum visit. She has a two year old son born at 40 weeks, a 5 year old daughter born at 38 weeks, and 7 year old twin daughters born at 35 weeks. She had a spontaneous abortion 3 years ago at 10 weeks. Using the GTPAL format, the nurse should identify that the client is:
- G4 T3 P2 A1 L4
- G5 T2 P2 A1 L4
- G5 T2 P1 A1 L4
- G4 T3 P1 A1 L4
6. Bleeding and cramping occur with the cervix closed and membranes intact.
7. Some of the products are expelled, but the placenta remains attached. Heavy bleeding and cramping doesn’t subside until entire placenta is removed.
8. Any of the 5 spontaneous abortions occurring with 3 consecutive pregnancies. This condition is a result of weakened cervix that dilates in the 2nd trimester, and expels the fetus. This condition is call INCOMPLETE CERVIX.
9. Embryo or fetus dies but isn’t expelled. It’s often discovered by the physician when no FHT is present. Fetus must be expelled within 6wks or DIC and/or infections can occur.
10. All of the products of conception are expelled.
Answers & Rationales
1. C. Dinoprostone (Prostin E.). The client with a missed abortion will have induction of labor. Prostin E. is a form of prostaglandin used to soften the cervix. Magnesium sulfate is used for preterm labor and preeclampsia, calcium gluconate is the antidote for magnesium sulfate, and Pardel is a dopamine receptor stimulant used to treat Parkinson’s disease; therefore, answers A, B, and D are incorrect. Pardel was used at one time to dry breast milk.
2. A. Hydatidiform mole. Hydatidiform mole begins as a pregnancy but early in the development of the embryo degeneration occurs. The proliferation of the vesicle-like substances is rapid causing the uterus to enlarge bigger than the expected size based on ages of gestation (AOG). In the situation given, the pregnancy is only 5 months but the size of the uterus is already above the umbilicus which is compatible with 7 months AOG. Also, no fetal heart beat is appreciated because the pregnancy degenerated thus there is no appreciable fetal heart beat.
3. B. Abruptio placentae. The major maternal adverse reactions from cocaine use in pregnancy include spontaneous abortion first, not third, trimester abortion and abruptio placentae.
4. A. “I will maintain strict bedrest throughout the remainder of pregnancy.” Strict bed rest throughout the remainder of pregnancy is not required. The woman is advised to curtail sexual activities until the bleeding has ceased, and for 2 weeks following the last evidence of bleeding or as recommended by the physician. The woman is instructed to count the number of perineal pads used daily and to note the quantity and color of blood on the pad. The woman also should watch for the evidence of the passage of tissue.
5. C. G5 T2 P1 A1 L4. 5 pregnancies; 2 term births; twins count as 1; one abortion; 4 living children.
6. E. threatened
7. C. incomplete
8. A. habitual
9. B. missed
10. B. complete